Osteoarthritis and Its Management

Introduction:

Osteoarthritis is a degenerative disease in which there is decreased production of hyaline cartilage, a protective cushion in the knee joint, and also decreased production of lubricant called synovial fluid. As the cushion tissue between the bones decreases, the upper and the lower bones of the legs touch each other causing friction. This starts damaging the surface and slowly erodes the bony tissue.

What Are the Signs and Symptoms of Osteoarthritis?

The most common symptoms are:

1. Deep achy joint pains exacerbated by excessive use. This is the primary symptom of osteoarthritis. Therefore squatting, climbing up and down the stairs, and lifting heavy weights are to be avoided.

2. The mobility of the joint decreases greatly, and crackling noises are heard during movement.

3. The affected joint may become stiff in the morning.

What Is the Cause of Osteoarthritis?

Osteoarthritis is believed to occur due to deterioration of the cartilage that cushions the ends of the bones of the joint. Cartilage is a slippery, firm tissue that ensures frictionless joint motion. If the cartilage wears down completely, the bones rub against each other. Generally, osteoarthritis is referred to as a wear and tear condition. It affects the entire joint, besides affecting the cartilage. It causes changes in the bone and damages the connective tissues holding the joints together and attaching the muscles to the bone. Osteoarthritis can also cause inflammation of the lining of the joint.

What Are the Risk Factors for Osteoarthritis?

People of all races and both sexes are equally affected by osteoarthritis. Generally, it occurs in people of age 40 and above. Nonetheless, it can occur sooner if the people have other risk factors or conditions that increase the risk of getting osteoarthritis. Risk factors include:

• Obesity - Excess weight puts more stress on joints, which increases the risk of osteoarthritis in that joint. Obesity can also have systemic effects that increase the risk of osteoarthritis.

• Older Age - The chances of developing osteoarthritis increase with age.

• Genetics - People with family members suffering from osteoarthritis have greater chances of developing the condition than the ones without the family history of this condition. Those who have hand osteoarthritis are more likely to have knee osteoarthritis.

• Joint Deformities - Deformities of joints such as bowlegs, unequal leg length, or knocked knees increase the risk of developing osteoarthritis.

• History of Traumatic Joint Injury or Repetitive Use of Joints - Injury or overuse like knee bending and repetitive stress on a joint can cause damage to the joint and increase the chances of developing osteoarthritis.

How to Diagnose Osteoarthritis?

Osteoarthritis can be diagnosed by physical examination, X-rays, and laboratory tests. During the physical examination, the doctor will check the affected joint for swelling, tenderness, redness, and flexibility. The other tests include:

• X-rays - X-rays show cartilage loss by narrowing of space between the bones in the joint.

• MRI (Magnetic Imaging Resonance) - An MRI is not commonly used in diagnosing osteoarthritis but can help in complex cases. This test uses radio waves and a strong magnetic field to create a detailed image of bone and soft tissues, including cartilage.

• Blood Test - There is no blood test to diagnose osteoarthritis, but it can help in ruling out other conditions causing joint pain.

• Joint Fluid Analysis - A needle is used to draw fluid from the affected joint and sent for testing. This is done to check for inflammation and to know whether the pain is caused by an infection or gout rather than osteoarthritis.

What Are the Treatment Options for Osteoarthritis?

There is no treatment yet that can be helpful in reversing joint damage due to osteoarthritis. The treatment plan focuses on reducing pain and improving the functioning of the affected joints. The best way to overcome the problem is to build a good mass of muscles around the joint as these muscles encircle the joint and provide stability to the joint and thereby decrease the pain by more than 50 %. The treatment options include:

• Physical Measures - Start physical exercises for the specific joint that has been affected. Weight loss and physical exercise are useful in cases of osteoarthritis. The patients should expose themselves to early morning sunlight for 10 to 15 minutes. Extra weight puts stress on the knee joints, hips, and lower back. Exercise improves muscle strength, lowers the chances of disability due to osteoarthritis, and decreases joint pain and stiffness. Support devices such as a walking cane or orthotics are also helpful in performing daily activities. Cold or heat therapy can be helpful in relieving pain and other symptoms. Alternative treatments such as massage, spa, and chiropractic manipulation are also helpful in relieving pain for a short period of time.

• Medications - Medications include oral, and topical medications, and injections. Topical drugs can be applied directly to the skin over the affected joints. Topical use of pain ointments may help temporarily. These drugs include Lidocaine gel, Capsaicin cream, and Diclofenac gel. Oral pain killers like Acetaminophen are the first choice of treatment. NSAIDs (nonsteroidal anti-inflammatory drugs) are given to reduce swelling and pain. Patients with severe pain need stronger medications, like prescription narcotics. Joint injections with a form of lubricant named hyaluronic acid or with corticosteroids can be given to relieve pain from osteoarthritis. These injection shots can delay the need for knee replacement by a few years in some cases.

• Supplements - A lot of over-the-counter supplements are used for osteoarthritis treatment. Patients are recommended to take calcium, vitamin D, and fatty acid tablets once a day.

• Surgery - Surgical treatment is an option in severe cases of osteoarthritis. This includes the cases where the medical treatment could not relieve pain and other symptoms and when the joint has serious damage or the patient has a major loss of function. One of the surgical options is arthroscopy. Arthroscopy is a less invasive procedure in which the repair is done through small incisions or cuts. When the joint damage is not repairable, then joint replacement is the option.

Conclusion:

Osteoarthritis is a condition of joints affecting millions of people worldwide. Osteoarthritis can affect any joint, but it commonly affects joints in the hands, hips, knees, and spine. Although the joint damage is irreversible, the symptoms of this condition can be managed. Maintaining a healthy weight, staying active and proper treatment can slow the progression of the disorder and help in relieving the symptoms.